Novel multimodal analgesia regimen improves post-TACE pain in patients with hepatocellular carcinoma

Guo, Jianguo; Zhao, Luping; Rao, Yuefeng; Gao, Yinping; Guo, Xuejiao; Zhou, Tianyu; Feng, Zhiying; Sun, Junhui; Lu, Xin-Jiang

doi:10.1016/j.hbpd.2018.08.001

Cited by 19 publications

(20 citation statements)

References 33 publications

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“…Multimodal analgesia was associated with superior pain relief and decreased opioid consumption when compared with use of a single pain medication[ 13 ]. Guo et al[ 8 ] demonstrated that patients who used preemptive parecoxib and a sufentanil-based multimodal analgesia regimen had better pain relief, evidenced by a lower incidence of severe pain (11.9%)[ 8 ]. Similar to a previous study[ 14 ], we observed that effective pain management could reduce the length of hospital stay.…”

Section: Discussionmentioning

confidence: 99%

“…Approximately 60%-80% of patients complained of different levels of pain after TACE. Among those patients, more than 25% experienced moderate-to-severe pain[ 7 , 8 ]. While TACE is generally understood to require hospital admission and at least a one-night in-patient stay[ 9 ], postembolization pain is primarily associated with an extended hospital stay[ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Predictive model for acute abdominal pain after transarterial chemoembolization for liver cancer

Bian

Zhao

Gao

et al. 2020

WJG

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BACKGROUND Transarterial chemoembolization (TACE) is the first-line treatment for patients with unresectable liver cancer; however, TACE is associated with postembolization pain. AIM To analyze the risk factors for acute abdominal pain after TACE and establish a predictive model for postembolization pain. METHODS From January 2018 to September 2018, all patients with liver cancer who underwent TACE at our hospital were included. General characteristics; clinical, imaging, and procedural data; and postembolization pain were analyzed. Postembolization pain was defined as acute moderate-to-severe abdominal pain within 24 h after TACE. Logistic regression and a classification and regression tree were used to develop a predictive model. Receiver operating characteristic curve analysis was used to examine the efficacy of the predictive model. RESULTS We analyzed 522 patients who underwent a total of 582 TACE procedures. Ninety-seven (16.70%) episodes of severe pain occurred. A predictive model built based on the dataset from classification and regression tree analysis identified known invasion of blood vessels as the strongest predictor of subsequent performance, followed by history of TACE, method of TACE, and history of abdominal pain after TACE. The area under the receiver operating characteristic curve was 0.736 [95% confidence interval (CI): 0.682-0.789], the sensitivity was 73.2%, the specificity was 65.6%, and the negative predictive value was 92.4%. Logistic regression produced similar results by identifying age [odds ratio (OR) = 0.971; 95%CI: 0.951-0.992; P = 0.007), history of TACE (OR = 0.378; 95%CI: 0.189-0.757; P = 0.007), history of abdominal pain after TACE (OR = 6.288; 95%CI: 2.963-13.342; P < 0.001), tumor size (OR = 1.978; 95%CI: 1.175-3.330; P = 0.01), multiple tumors (OR = 2.164; 95%CI: 1.243-3.769; P = 0.006), invasion of blood vessels (OR = 1.756; 95%CI: 1.045-2.950; P = 0.034), and TACE with drug-eluting beads (DEB-TACE) (OR = 2.05; 95%CI: 1.260-3.334; P = 0.004) as independent predictive factors for postembolization pain. CONCLUSION Blood vessel invasion, TACE history, TACE with drug-eluting beads, and history of abdominal pain after TACE are predictors of acute moderate-to-severe pain. The predictive model may help medical staff to manage pain.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictive model for acute abdominal pain after transarterial chemoembolization for liver cancer

Bian

Zhao

Gao

et al. 2020

WJG

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“…27,28 Through active intervention, the CPGT in the FAHZJ has achieved several improvements, such as increasing the rationality of using prophylactic antibiotics in intervention procedures, 26 enhancing the efficacy of cancer pain therapy, and improving postoperative pain of transarterial chemoembolization in patients with hepatocellular carcinoma. 29 In 2015, the enhanced recovery pathway was introduced in the FAHZJ to improve outcomes for surgical patients. In line with the initiative, a group of dedicated clinical pharmacists collaborated with abdominal surgery teams to supply surgical pharmacy service.…”

Section: What Is K Nown and Objec Tivementioning

confidence: 99%

Pharmacist‐driven multidisciplinary initiative continuously improves postoperative nausea and vomiting in female patients undergoing abdominal surgery

et al. 2020

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What is known and objective The incorrect or insufficient prophylaxis of postoperative nausea and vomiting (PONV) is common in practice. A clinical pharmacist‐led guidance team (CPGT) was established and included in general surgery teams. Objective This study aimed to evaluate the effects of the CPGT on the improvement of PONV and prophylaxis administration. Methods A prospective before‐after study was conducted on 156 female patients undergoing abdominal surgery at a Chinese tertiary teaching hospital from December 2016 to December 2017. A total of 82 patients were enrolled in the preintervention period, and 74 patients were included in the post‐intervention period. The CPGT established the evidence‐based criteria for prophylactic anti‐emetic administration and conducted interventions, including a review of medical records, provision of feedback, educational outreach, and dedicated support. Primary outcomes included the incidence of PONV within 24 hours of surgery, administered number of prophylactic anti‐emetics, and accuracy of the timing for prophylactic anti‐emetics. Outcomes were analysed by logistic regression or multivariable linear regression. Results and discussion After intervention, patients reported significantly less PONV (33.78% vs 56.10%; odds ratio [OR]: 0.29; numbers needed to treat [NNT]: 3.47), vomiting (29.73% vs 45.12%; OR: 0.42; NNT: 5.16) and nausea (31.08% vs 56.10%; OR: 0.24; NNT: 3.19) within 24 hours of surgery. The accuracy of the timing for prophylactic anti‐emetics significantly increased (OR: 3.66; P: .003). Anaesthesiologists administered increased numbers of prophylactic anti‐emetics (OR: 5.82; P < .001). The improvement of PONV did not decrease during the four‐month period after intervention (P: .639). What is new and conclusion The CPGT is a valuable service model to continuously improve PONV and optimize prophylaxis administration.

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“…Although the most commonly used therapeutic approach for such patients is TACE,2 there is a wide gap between guidelines and applied clinical practice, many therapeutic approaches, such as downstaging such patients with percutaneous ablation or radio-embolization followed by radical resection, have been reported 4–6…”

Section: Intermediate Stage Hcc and Tacementioning

confidence: 99%

<p>Intermediate stage hepatocellular carcinoma: a summary review</p>

Elshaarawy¹,

Gomaa²,

Omar³

et al. 2019

JHC

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It is well known that intermediate stage hepatocellular carcinoma (HCC) encompasses the widest class of patients with this disease. The main characteristic of this special sub-group of patients is that it is extensively heterogenous. This substantial heterogeneity is due to the wide range of liver functions of such patients and variable tumor numbers and sizes. Real world clinical data show huge support for transarterial chemo-embolization (TACE) as a therapeutic modality for intermediate stage HCC, applied in 50%–60% of those class of patients. There are special considerations in various international guidelines regarding treatment allocation in intermediate stage HCC. There is an epidemiological difference in HCC in eastern and western cohorts, and various guidelines have been proposed. In patients with HCC, it has frequently been reported that there is poor correlation between the clinical benefit and real gain in patient condition and the conventional way of tumor response assessment after locoregional treatments. This is due to the evaluation criteria in addition to the scoring systems used for treatment allocation in those patients. It became clear that intermediate stage HCC patients receiving TACE need a proper prognostic score that offers valid clinical prediction and supports proper decision-making. Also, it is the proper time to study more treatment options beyond TACE, such as multimodal regimens for this class of patients. In this review, we tried to provide a summary of the challenges and future directions in managing patients with intermediate stage HCC.

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Novel multimodal analgesia regimen improves post-TACE pain in patients with hepatocellular carcinoma

Cited by 19 publications

References 33 publications

Predictive model for acute abdominal pain after transarterial chemoembolization for liver cancer

Predictive model for acute abdominal pain after transarterial chemoembolization for liver cancer

Pharmacist‐driven multidisciplinary initiative continuously improves postoperative nausea and vomiting in female patients undergoing abdominal surgery

<p>Intermediate stage hepatocellular carcinoma: a summary review</p>

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